Immunization Preventable Diseases, Global and National Context, Evidence-based public health

1. Global and National
Achievement in
Evidence Based
Public Health:
Vaccine Preventable
Diseases
Bimal Patel
Harish Prasad Bhatta
CDPH,IOM
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2. • From at least 15th century, people were
practicing variolation.
• In May 1796, English physician Edward
Jenner inoculates 8-year-old James Phipps
with matter collected from a cowpox sore.
• Two months later, in July 1796, Jenner
inoculates Phipps with matter from a
human smallpox sore in order to test
Phipps’ resistance.
• Phipps remains in perfect health, and
becomes the first human to be vaccinated
against smallpox.
• The term ‘vaccine’ is later coined, taken
from the Latin word for cow, vacca (8).
Discovery of vaccine
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3. Chronology of vaccine development (7)
2019: Malaria
2019: Dengue
2019: Ebola
2020: COVID-19
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4. Safe and effective vaccines (8)
Z
Y X
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5. Global Vaccine Action Plan 2011-2020
• GOAL 1 Achieve a world free of poliomyelitis
• GOAL 2 Meet global and regional disease-elimination
targets, including neonatal tetanus, measles and rubella
elimination targets.
• GOAL 3 Meet vaccination coverage targets in every
region, country and community.
• GOAL 4 Develop and introduce new and improved
vaccines and technologies
• GOAL 5 Exceed the MDG 4 target for reducing child
mortality.
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6. Global Achievements (1)
• Small pox eradicated in 1980
• Wild poliovirus type 2 was certified as eradicated in 2015 and wild poliovirus
type 3 has not been detected since 2012. Wild poliovirus type 1 currently
appears to be circulating only in Afghanistan and Pakistan.
• A total of 82 countries have eliminated measles, but large outbreaks
occurred in all WHO regions in 2018.
• As of 2018, 168 out of 194 countries have implemented rubella vaccination
and one WHO region is rubella-free.
• As of July 2019, only 28 out of 40 priority countries have eliminated
Maternal and neonatal tetanus.
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7. Global Achievements
• Only about 1/3rd of countries in 2018 meet the target of 80% or greater
DTP3 coverage in every district. Global vaccine coverage for DTP3 has
plateaued at 86% since 2010
• Over 80% of LMICs have introduced new vaccines since 2010.
• Between 2010 and 2017, the mortality rate of children under 5 years of age
decreased by 24%, due in large part to immunization.
• Between 2010 and 2018, 23 million deaths were averted with measles
vaccine.
• More than 20 life-threatening diseases can now be prevented by
immunization.
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8. Vaccine preventable disease:
An Evidence Based Public Health Practice
The practice of evidence-based public health (EBPH) is an integration
of science-based interventions with community preferences for
improving population health.
Immunization reaches more people than any other health or social
service. It is an investment in the future, in three ways.
• Saving lives and protecting the health of populations
• Improving countries’ productivity and resilience
• Enabling a safer, healthier, more prosperous world
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9. Saving lives and protecting the health of populations
• Between 2010 and 2017, the mortality rate of children under 5 years
of age decreased by 24%, due in large part to immunization.
• In countries that have introduced the vaccine against human
papillomavirus (HPV), after 5–8 years, cancer causing HPV prevalence
was reduced by 83% among girls aged 13–19, and the prevalence of
precancerous lesions decreased by 51% among girls aged 15–19.
• Results from a Lancet study show that during the first year of
immunization against COVID-19 (December 2020 to December 2021)
vaccinations prevented at least 14.4 million deaths globally.
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10. Improving countries’ productivity and resilience
• Immunization against measles in 94 low- and middle-income
countries returned an estimated US$ 76.5 for every US$ 1 invested in
vaccination.
• Vaccines will help keep an estimated 24 million people from falling
into poverty by 2030.
• The full economic impact of the 2014– 2016 outbreak of Ebola virus
disease in West Africa has been estimated at US$ 53.2 billion.
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11. Enabling a safer, healthier, more prosperous world
• Climate change between 2030 and 2050 is expected to cause 60 000
additional deaths from malaria per year. This trend may be changed by
use of a malaria vaccine being pilot tested in three African countries.
• It is estimated that widespread use of the pneumococcal conjugate vaccine
(PCV) could reduce the number of days on antibiotics for pneumonia in
children under 5 years by 47%, equivalent to 11.4 million days on
antibiotics per year (10).
• A 10% increase in the core capacities required by the International Health
Regulations (2005) (e.g. immunization, disease surveillance) is associated
with a 19% decrease in the incidence of cross-border infectious threats.
• Immunization plays a critical role in achieving the SDGs, specifically SDG3,
and also contributes directly or indirectly to 13 other SDGs.
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12. Global impact of the first year (Dec 8, 2020, and Dec 8, 2021)
of COVID-19 vaccination
•Vaccinations prevented 14·4 million deaths from COVID-19 in
185 countries.
•A global reduction of 63% in total deaths.
•In low-income countries, an additional 45% of deaths could
have been averted if vaccination coverage was 20%.
•An additional 111% of deaths could have been averted if 40%
target set by WHO been met by each country by the end of
2021.
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14. National Immunization Program (NIP)
• The National Immunization Program (NIP) of Nepal (Expanded
Program on Immunization) was started in 2034 BS.
• Several milestones contributing to reduction in morbidity, mortality
and disability associated with vaccine preventable diseases.
• Currently, the program provides vaccination against 13 vaccine-
preventable diseases through almost 16,000 service delivery points
in health facilities (fixed sessions), outreach sessions, and mobile
clinics.
• Target group: <15 months children and pregnant mothers
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18. National Immunization Program schedule
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19. National Immunization Program schedule
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20. National Immunization Program schedule
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21. South East Asia Regional Vaccine Action Plan
2016-2020
• GOAL 1 Routine immunization systems and services are
strengthened
• GOAL 2 Measles is eliminated and rubella/CRS
controlled
• GOAL 3 Polio-free status is maintained
• GOAL 4 Elimination of maternal and neonatal tetanus
is sustained
• GOAL 5 Control of Japanese encephalitis is accelerated
• GOAL 6 Control of hepatitis B is accelerated
• GOAL 7 Introduction of new vaccines and related
technologies is accelerated
• GOAL 8 Access to high quality vaccines is ensured 21

22. National Achievements
• Smallpox free status since 2034 BS and global eradication in 2037 BS
• Maternal and neonatal tetanus (MNT) eliminated in 2005 and sustained
• The last case of polio seen in 2010, certified polio free in 2014 and sustained
• In 2016 JE vaccine, scaled up all over the country.
• Control of rubella and congenital rubella syndrome Aug 2018 (2 years ahead
of the regional target and one year ahead of the national target of 2019)
• Hepatitis B control among children through immunization July 2019. (Nepal
became fourth country in the WHO SEAR to control hepatitis B among children.
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23. National Achievements
• The national target of achieving measles elimination by 2019 has not
been met (new target eliminate MR by 2023)
• Overall, the NIP is considered as the main contributor towards decline
of infant and child mortality and has contributed significantly in
achieving MDG Goal 4.
• Since FY 2069/70 (2012/2013), Nepal has initiated ‘full immunization
program’. By the end of FY 2078/79, 70 out of 77 districts have been
declared ‘fully immunized’ under this program.
• Nepal is the first country in the SEAR to have an Immunization Act
2072 (Provincial Immunization Act as developed)
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24. VACCINE-PREVENTABLE DISEASES SURVEILLANCE:
An evidence based public health
• WHO-IPD provides technical assistance to the MoHP for nation-wide
surveillance systems for acute flaccid paralysis (for polio), measles
and rubella, neonatal tetanus, and acute encephalitis syndrome (for
Japanese encephalitis).
• Further, with support of WHO-IPD, sentinel surveillance of selected
vaccine preventable diseases (invasive bacterial diseases, rotavirus,
and congenital rubella syndrome) is conducted in collaboration with
academic institutions.
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25. VACCINE-PREVENTABLE DISEASES SURVEILLANCE
• To support polio eradication activities, surveillance of acute flaccid
paralysis for polio was started in 1998.
• In 2003, MR & neonatal tetanus surveillance integrated into
surveillance network.
• In 2004, surveillance of acute encephalitis syndrome for JE integrated
• Surveillance through 734 routine weekly zero-reporting sites, 630
case-based measles surveillance sites, and 817 informers.
• Sentinel surveillance for invasive bacterial diseases (pneumococcus,
Hib, and meningococcus) at Patan Hospital since 2009.
• Sentinel surveillance for rotavirus disease at Kanti Children’s Hospital
since 2009.
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26. VACCINE-PREVENTABLE DISEASES SURVEILLANCE
• In February 2018, rotavirus sentinel surveillance sites were expanded– B.P.
Koirala Institute of Health Sciences and Nepalgunj Medical College.
• Further, sentinel surveillance of CRS (congenital rubella syndrome) is
conducted through four sentinel sites in Kathmandu Valley- Kanti Children’s
Hospital, Tribhuvan University Teaching Hospital- Paediatric Department,
Patan Academy of Health Sciences and Tilganga Eye Hospital.
• Surveillance data from the IBD sentinel surveillance site was crucial for
the informed introduction of the Haemophilus influenzae type b vaccine
(introduced in 2009), and the pneumococcal conjugate vaccine
(introduced in 2015) in routine immunization of Nepal.
• Similarly, data from the rotavirus sentinel surveillance site was crucial for
an informed recommendation for the rotavirus vaccine introduction in
Nepal.
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27. The changing context and challenges
• Sustaining trust in vaccines and immunization services in communities
(misinformation, anti-vaccine messaging on social media).
• Ensuring immunization for all ages: the significant global
demographic shifts (Africa region “youth bulge” vs significant
population ageing in other region) will have a major impact on the
design of immunization services.
• Climate change and natural disasters: vector-borne diseases,
waterborne diseases, disrupting seasonal disease pattern, alter
endemicity of infectious diseases, environmental impact of vaccine
waste.
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28. • Conflict and political instability: loss of health service infrastructure and
shortages of trained health workers, disrupting delivery of immunization
services also the affected populations are frequently at higher risk of
infectious diseases.
• Outbreaks: outbreaks of measles, yellow fever, diphtheria and other
vaccine-preventable diseases and also emerging infections, such as Ebola
virus disease.
• Optimizing and maintaining supplies: mismatch between global
production levels and needs, price of vaccines can delay the introduction of
new vaccines into low- and middle-income countries, regulatory, financing
and procurement barriers to sustainable vaccine supplies.
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29. References
1. Immunization agenda 2030 : A global strategy to leave no one behind
2. Implementing the immunization 2030 agenda
3. The global vaccine action plan 2011-2020: Review and lesson learned
4. SEAR vaccine action plan 2016-2020
5. Global vaccine action plan 2011-2020
6. DoHS Annual report 2078/79
7. National immunization program: Reference book for health workers 2079
8. WHO: vaccine preventable disease
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30. Thank you
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37. Global impact of the first year of COVID-19
vaccination
Based on official reported COVID-19 deaths, we estimated that vaccinations
prevented 14·4 million (95% credible interval [Crl] 13·7–15·9) deaths from COVID-
19 in 185 countries and territories between Dec 8, 2020, and Dec 8, 2021.
This estimate rose to 19·8 million (95% Crl 19·1–20·4) deaths from COVID-19
averted when we used excess deaths as an estimate of the true extent of the
pandemic, representing a global reduction of 63% in total deaths (19·8 million of
31·4 million) during the first year of COVID-19 vaccination.
In COVAX Advance Market Commitment countries, we estimated that 41% of
excess mortality (7·4 million [95% Crl 6·8–7·7] of 17·9 million deaths) was averted.
In low-income countries, we estimated that an additional 45% (95% CrI 42–49) of
deaths could have been averted had the 20% vaccination coverage target set by
COVAX been met by each country, and that an additional 111% (105–118) of
deaths could have been averted had the 40% target set by WHO been met by each
country by the end of 2021.
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